Automating Central Sterile: Instrument Tracking Systems in Action
By Kris Ellis
More and more healthcare facilities are realizing the many benefits of surgical instrument tracking systems. From increasing employee productivity to decreasing unnecessary expenditures, tracking systems are proving their worth in central sterile (CS) and beyond.
Considering the millions of dollars that many facilities have invested in their medical devices and surgical instruments, protecting that investment is a significant concern. You talk to anybody in the industry and were losing thousands of dollars over months or years or what have you on all these replacement costs, says Richard Schule, BS, CST, CRCST, CHMMC, FEL, manager of the processing department at Cleveland Clinic Foundation.
Here we can narrow it down to who the victims are, or what services are more problematic than others, or what particular devices are more problematic and need to be replaced because were capturing that data; were identifying that when were assembling the instruments, and on a daily or weekly or monthly basis I can provide that information to our customers and show them the trends.
When it comes to producing documentation on instruments, automation is the way to go. The documentation piece, for systems out there that are manual and laborious and intensive as far as collecting data, people have to be responsible for collecting that data at the end of the day, and then at the end of the month theyre always pulling stuff together, Schule says. Here its all scanned in by bar code, and its all real time, so it just makes the process very efficient.
Nancy Chobin, RN, CSPDM, SPD/CS educator for Saint Barnabas Health Care System, explains that planning the implementation of the tracking system in her facility gave CS personnel a renewed sense of confidence in executing their duties and responsibilities. Most people in CS are always getting blamed for everything, she says. Its so nice to have some accountability and be able to track things through your department and know who did it and when they did it and how they did it, which was really something they were looking forward to and very excited about.
Chobin points out that her facilitys system, TRILOGY from Healthcare Systems Management, features an extensive training module that includes 700 competency-based questions on the care, handling and identification of basic surgical instruments. There are also crossword puzzles, theres a word find, theres parts of an instrument scattered all over and you have to construct the instrument, and if you come up with the wrong answer, it not only tells you that the answer is wrong, but also what the correct answer should be, Chobin continues. The learning is reinforced at all times, and that training can be bookmarked at any time and it keeps track of where you were. The supervisor can print out a report and you can get 20 CEUs for it.
Schule can also attest to the advantages of the computer-based training that many tracking systems can provide. Its huge, he says. We have a tutorial that gets them through, and before they know it theyre online within a few days and then within a month they have no problems whatsoever.
Schule explains that the ability to customize the tutorial is particularly helpful in preserving valuable resources. Weve added pictures of instrumentation so when they bring up a count sheet and theyre not sure what the tray looks like, they can bring up a picture right there; the training modality is quickly expedited through visuals and pictures, so we dont have to waste a second person shadowing them it tells you everything you need to know, he says. You click on a product number and theres the clamp or theres the knife handle. It cuts back on the labor you need for training.
Chobin says basic features such as scanning instruments and dealing with count sheets are quick and easy to learn and put into practice. Other options, such as adding custom instructional videos, may evolve more slowly depending on the time CS staff can devote to the system.
You can download videos not only for training but also for refreshing someone, Chobin explains. So if I was doing a tray and it tells me that this particular device needs to be lubricated, and I havent done this in a long time and I dont remember how to do it, I can click on the video icon and it will bring up the video of how to lubricate the drill.
Chobin explains that a streamlined system that is capable of being customized can be very attractive. One of the beautiful things about our system is its simplicity, she says. We dont have a lot of bells and whistles. I like simplicity; why give me 200 reports when theres only three or four that Im going to really use? Im wasting paper, Im wasting electricity, and no one else is going to read them either. It can be customized to give you any report that you want, but we try to keep the system very simple.
Another feature that has proved useful at Saint Barnabas is instant messaging. Operating room (OR) personnel are able to send an instant message to the CS supervisor, who then can send it to everyone in the department, or to individual workstations. I can get an instant message up on my screen that says the OR needs a Metzenbaum scissor Room 7 STAT. I can either send it to the case cart area, or I can send it to everybody and say Does anyone have one thats sterile? Let me know immediately, and they can respond back to me. The staff loves it because they dont even have to get up to answer the phone its right there on the screen. The instant messaging has really been a hit.
Chobin notes that the everyday interaction between the OR and CS can be greatly enhanced through the use of a tracking system. For example, one day last summer I counted no less than 43 phone calls in an eight-hour shift, and the majority of them were for devices that were already in the OR, she says. This is common all over; this is the way it is, she says. With the tracking system we can tell them exactly when it was sent up.
Schule explains that the uses and benefits of instrument tracking are certainly not limited to the OR and CS. My colleagues and peers, the nurse managers, managers in charge of the various services, they find this extremely beneficial when theyre trying to plan capital budgets at the end of the year getting ready for the upcoming year, he says. I can show through histograms or usage reports on a particular tray of instruments where we spiked and if we have so many on hand. For example, say if we have 10 trays, and throughout the year we had need on several occasions for 12 or 13, it gives them ammunition to go and get $3,000 to add another tray to the inventory. On the flip side, it shows those trays that are just sitting stagnant on the shelf, and we can pull those devices off, bring them down and build trays that we need, so its better utilization of the minor equipment or surgical instruments.
Most people just want to get a tracking system in to find out where their instruments are and where theyre going, says Chobin. However, she reiterates the fact that automated instrument tracking offers an array of useful features that should be taken advantage of. I get very frustrated because a lot of people have spent this money on tracking systems and theyre really not utilizing them to their full potential, she explains. They scan a tray when it comes into decontam, but it doesnt get scanned again until someone picks it up to prep for packaging. I want to know not only when that tray came into decontam, but I also want to know how long it took for somebody to put their hands on it, because if the OR calls me, thats affecting my turnover time. It may also be affecting my employee utilization they may need to put more people in decontam. We can track station utilization, people utilization, tray utilization, and the more you scan, the more finite, the more real-time your information. Most people just want to scan to get their productivity and know this tray went through here and thats it. I just feel that if youre going to spend the money for a tracking system that you want to have really detailed information to know who did it, how they did it, when they did it, and why they did it.
Accounting for instrumentation can save countless hours of miscommunication and searching, allowing clinicians to concentrate on what matters most. Here we just push a couple buttons and find out where it was last scanned and nine out of 10 times, there it is, says Schule. So that offset in lost labor costs is also huge, which allows the perioperative staff to concentrate on patient care and not worry about having to look for a device.
The surgical processing department at Schules facility has earned the distinction of ISO (International Organization for Standardization) 9001:2000 certification, thanks in part to effective utilization of its tracking system, Sterile Processing Microsystem (SPM) from Materials Management Microsystems. Several specific features of the system were key in making this effort successful, according to Schule.
One such feature involves the creation of templates for sterilization of certain devices. When we build a template for a medical device, we add in there that a biological is required, or a device needs to be exposed to a certain sterilant modality steam, gas, plasma or ozone, Schule explains. They asked what our preventative measures were, or what our quality was in ensuring that happens. Based on that bar code, we showed them that you cant scan this device into any other modality than whats dictated by the computer system, which was a huge piece.
Schule describes another example in which corrective action was put in place in response to an event in which unsterile instruments made their way to the OR. We rewrote a program, and now a device has to be mapped back to a sterilization load. In other words what will happen is if you try and scan a tray that hasnt been run through a sterilization load, it will come up on the screen that the device is unsterile, preventing us from sending it upstairs. Those all triggered or helped support us going after the ISO certification.
As far as specific application to the infection control effort, Chobin contends that instrument tracking has much to offer. I think now with the new Joint Commission on Accreditation of Healthcare Organizations (JCAHO) tracer methodology, this is going to be really invaluable, although they havent required it, she says. I think with all of the issues weve had with CJD (Creutzfeldt-Jakob disease), even though its extremely rare, weve seen several instances of not screening patients appropriately or not having the information and then having to go back and follow up on 700 or 900 patients now youll know exactly which set was used on that patient and what patient subsequently had that set. In my opinion, its going to be required in the next couple of years.